The present paper attempts to know if medical tourism above all aesthetic surgery
presents a good solution to save the Tunisian tourism sector imbalance by green revolution and
corona virus and absorb the unemployment of both doctors and workers in tourism sector or not.
Medical tourism Case of aesthetic surgery: is a compulsory orientation and a good solution for Tunisia tourism?
1. International Journal of Business Marketing and Management (IJBMM)
Volume 6 Issue 12 December 2021, P.P. 25-31
ISSN: 2456-4559
www.ijbmm.com
International Journal of Business Marketing and Management (IJBMM) Page 25
Medical tourism Case of aesthetic surgery: is a
compulsory orientation and a good solution for Tunisia
tourism?
sawssen NAFTI
Faculty of Economics and Management of Sousse Laboratory, University of Sousse Street of Khalifa El Karoui
Sahloul - BP n° 526 - 4002 Sousse Tunisia
sawssen_nafti@yahoo.fr
ORCID identifier: 0000-0002-4022-7467
Abstract: The present paper attempts to know if medical tourism above all aesthetic surgery
presents a good solution to save the Tunisian tourism sector imbalance by green revolution and
corona virus and absorb the unemployment of both doctors and workers in tourism sector or not.
Firstly, by analyzing the place of tourism in Tunisian economic strategy of development. Then via the
determination of limits of mass tourism in Tunisia.Finally through the analysis of different solutions
given by medical tourism especially cosmetic surgery. According to our analysis, green revolution
and COVID-19 pandemic has caused an unprecedented economic, social and financial crisis in
Tunisia for tourism sector which is suffer before of various difficulty. The medical tourism can be
considered a good solution for Tunisian tourism and orient it towards to sustainable tourism. But
some issues attached by tourism raised require urgent short-term solutions, while others require a
more long-term or structural change.
Keywords: tourism, medical tourism, esthetic tourism, COVID 19, crisis.
I. Introduction
Tunisia is located at the junction of the eastern basin and the western basin of the
Mediterranean at the northern tip of Africa. Tunisia enjoys a pleasant climate for a good period of the
year. This geographical position, which made Tunisia a crossroads of civilizations in the past, makes
it today a hub for Medical Tourism as well as for aesthetic tourism. In fact, green revolution, corona
virus, have drastically reduced tourists in Tunisia. The pandemic context would have served as a good
indicator and gas pedal of the development of sustainable tourism instead of the mass tourism of the
preCOVID 19. Firstly, we will present the structure of tourism in Tunisia. In a second part, we will
present medical tourism and its advantages to Tunisia economy. In a third part, we will present the
results of medical cosmetic surgery tourism in reducing employment and in development of
sustainable tourism
II. Tourism in Tunisia: Brief history and structure
II-1-Brief history of Tunisia tourism
Tourism in Tunisia is one of the most dynamic sectors of the economy and origin of foreign
exchange for the country. Tourism has a ripple effect on other economic sectors, such as transport
also communications, crafts, commerce and construction. In Tunisia, the exploitation of the sun and
the shores, for nearly 6 decades, has generated a spectacular development of the mass seaside hotel
industry. Tunisia's strategic geographical position in the south of the Mediterranean basin, with 1,300
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International Journal of Business Marketing and Management (IJBMM) Page 26
kilometers of largely sandy coasts, a warm Mediterranean climate in summer and mild in winter, a
very rich civilizational heritage , in addition, a very low cost of transport. All these characteristics
make this country one of the main destinations for European tourists in Africa and the Arab world. In
2010, tourism contributed 7% to the GDP, generated between 18 and 20% of foreign exchancovered
56% of the trade deficit and provided 400,000 jobs. The political instability that followed the 2011
revolution have drastically reduced tourist numbers in the country. These political and security crises
have been caught up in its recovery by the COVID-19. In fact, the pandemic context would have
served as an indicator and gas pedal of the development of a "sustainable tourism" in place of the
mass tourism of the preCOVID.
II-2-Tourism structure in Tunisia
Tourism is an old activity, which in the 20th century took on a global dimension. It now
constitutes a fundamental economic sector in many developed countries as well as in developing
countries such as Tunisia, which make it an essential factor in their development. Today tourism
represents the first service industry in the world. No one can ignore nowadays, the capital role that
tourism can play as a driving sector of economic and social development in Tunisia. This sector is the
main source of job creation. Since the 1970s, the tourism system in Tunisia has produced mass
seaside tourism, concentrated in coastal towns. The tourist infrastructure mainly seaside is often
equated with the hotel industry. This monoactivity, being favored by a certain sectoral policy, was
responsible for the current tourist crisis with all its dimensions economic, social and environmental.
The political instability that followed the 2011 revolution and corona virus have drastically reduced
the number of tourists in the country. The priority of Tunisian tourism stakeholders today is therefore
to restart this sector. At the same time, awareness of environmental issues has emerged in recent years
to promote the development of a new type of more sustainable tourism. The prospect of developing
sustainable and responsible tourism must be part of a value chain and contribute to the reduction of
social and territorial disparities through an inclusive approach. To this end, the pandemic would have
served as an indicator and accelerator of a rapidly changing business. Everything is in favor of "soft
tourism" instead of pre-COVID mass tourism. Tunisia like many countries has been affected by this
paradigm shift. Sustainable tourism involves the preservation of natural resources and cultural
heritage while respecting local communities and their interests as well as those of visitors and future
generations. Thus, under the effect of the pandemic, the health dimension incorporates this concept of
alternative tourism. In addition, the overhaul of tourism and its system should thus be part of a long-
term, global and integrated approach, which mobilizes all the actors of the territories-destinations
concerned. The actors of the tourism sector in Tunisia have a duty to take an interest in the
implementation of a sustainable development strategy. However, the aim of the sustainable
development strategy is to promote positive effects and limit negative effects, especially in ecological
and social terms. Even if the concept of sustainable development arose from debates related to
ecological requirements, the sustainability of economic growth is not limited to these. “Sustainable”
tourism growth is based on the implementation of a quality policy rather than that of quantitative
growth. Its mode of development imposes a different behavior on the suppliers and their visitors
III. Medical tourism
III-1- Definition of medical tourism
Medical tourism is defined as a medical trip for a patient whose purpose is to seek treatment
in a third country at lower costs than those in his country of origin. This branch of tourism has
developed thanks to agencies specializing in the medical field but also thanks to hospitals and the
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International Journal of Business Marketing and Management (IJBMM) Page 27
entire medical profession in the host countries. Among the main destinations known for their medical
quality services and their unbeatable prices, we find Tunisia and Thailand, known for its cosmetic
surgeons. Tunisia which therefore remains the most coveted destination and leader in the cosmetic
surgery sector. Medical tourism is no longer seen only as a simple hospitalization. The liberation of
the individual from the legislative framework raises many questions ethical and deontological.
Questions raised about the development of medical tourism in the world and in emerging countries
specially Tunisia, its aspects ethics as well as the role of marketing in its promotion, identify the
problem and issues related to medical tourism. Certain Maghreb countries such as Tunisia have a
particularly rich infrastructure and relevant skills-health. However, the major geopolitical changes
underway are not without relaunch global competition. However, by building on these strengths and
targeting a local market, medical tourism could serve as a lever for development, leading to the
country's commercial boom but also to an update level of hospital infrastructure. The existence and
growth of medical tourism in Tunisia cannot be do without the support of State, motivated by the
income generated by the flow of patients. The sector has become attractive, to such an extent that it
has led some countries to initiate considerable policies in favor of this strategic axis. The globalization
of the healthcare market contributes to the creation of poles intended to receive international tourist-
patients.
Waiting times for different surgical procedures, in number of days
Source: Organization for Economic Co-operation and Development (OECD), The OECD Health Project.
Towards more efficient health systems, 2004
Surgical options in major medical tourism countries
Source: Organization for Economic Co-operation and Development (OECD), The OECD Health Project.
Towards more efficient health systems, 2004
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III-2- Definition of aesthetic tourism
Aesthetic tourism is a segment of medical tourism. The patient's objective is to benefit from
plastic and aesthetic surgery care in a country different from the country where one resides. As in
Brazil, highly coveted by American patients, aesthetic tourism in Tunisia corresponds to the branch of
medical tourism most requested by European patients. Since the early 2000s, the country has become
one of the major destinations for aesthetic tourism in the world. Tunisia is at the head of the line of
countries offering plastic surgery procedures under high security and at unbeatable prices.
III-3- Cost of aesthetic tourism in Tunisia
The main factor that explains this phenomenal increase in medical tourism is the cost of
interventions. Indeed, if we take the example of cosmetic surgery in Tunisia, It should be noted that
the total cost of an intervention is sometimes up to 60% cheaper than the cost of the simple operation
in Europe. When we talk about total cost, it therefore includes: The plane ticket, Accommodation at
the clinic, Accommodation at the hotel for the convalescence period, All costs of the surgery and
related costs, The fees of the surgeon, The fees of the anesthetist, The fees of a general practitioner
sometimes necessary for postoperative follow-up, but above all the personalized supervision of the
patient throughout the stay.
IV. The need for a transformation from seasonal tourism to medical sustainable tourism
Medical tourism can be a real asset for Tunisia. This sector can contributes to the integration
of Tunisia into the world economy. This phenomenon also has significant repercussions, especially in
terms of economic development and spatial enhancement. In this way, we can propose the creation of
"medicity", these medical complexes which combine cutting-edge medicine and competitive prices, in
an environment composed of modern hospitals but also hotel complexes, apartments or even private
companies. Tunisia is well placed in terms of medical tourism thanks to highly qualified and
specialized medical and surgical teams. In addition, in terms of cost, Tunisia remains competitive:
staff are less expensive and social charges lower, not to mention that the exchange rate fully favors
health tourists. Of course, Tunisia has invested in clinics that respond to the care offered.
Nevertheless, the development of a program to upgrade the sector is essential in order to accredit
health institutions to international standards. As a result, Tunisia will be well placed to become a
privileged destination in terms of health tourism
Tunisia is located at the junction of the eastern basin and the western basin of the Mediterranean at the
northern tip of Africa. Tunisia enjoys a pleasant climate for a good period of the year. This
geographical position, which made Tunisia a crossroads of civilizations in the past, makes it today a
hub for investment as well as for trade and commerce with other nations of Europe, Africa. and the
Middle East. Health is well developed in Tunisia both in the public sector and in the private sector,
especially in greater Tunis.
Health tourism is a booming activity in Tunisia. The origins of this development is individual
initiatives such us clinic, doctors, etc. However, the institutional initiatives is less structured.
In this way, we propose some solutions to develop the sector of medical tourism in order to
strategically position of Tunisia as a regional leader:
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International Journal of Business Marketing and Management (IJBMM) Page 29
- The creation of a structure specializing in the promotion of exports and investments for the health
sector also the encouragement of investment in the sector.
- The development of a plan for the creation of a medical city and health zones which host health and
medical projects intended for export.
- The encouragement of elderly tourists to stay living for a long periods in Tunisia, in tourist centers
or in residences built for this aim for example tourist health villages.
- The development of a program to improve the sector in the aim to accredit health institutions to
international standards. In this way, this will allow foreign patients French, English, Italians,..to be
covered by their health insurance fund.
- The organization of a partnerships between the public and private health sectors, in order to
boosting exports the quality of medical services.
-The realization of a strategic study on the sector in order to decide on a national strategy and to
specialize in the offer of care.
-The establishment of partnership relationship with different hotels in the aim to export various
medical and activities to them, directly serving tourists.
-The encouragement of development of the creation of proximity centers in neighboring countries
(Libya, Algeria, Mauritania, etc.) in the aim to attract patients from these countries for heavy care in
Tunisia.
-The establishment of "health packages" ,beauty treatments, check-ups, with tourist tour operators
and offer them to their customers. In this way, tour operators should be the main partners in the
dissemination and development of information of medical tourism services established by Tunisia
V. Conclusion
This paper was dedicated a theorical study to know if medical tourism above all aesthetic
presents a good solution to solve the problems of Tunisian tourism sector imbalance by green
revolution after 2011 and corona virus after 2020 and absorb the unemployment of both doctors and
workers in tourism sector or not. The results clearly show that green revolution and COVID-19
pandemic has caused an unprecedented economic, social and financial crisis in Tunisia for tourism
sector which is suffer before of various difficulty. The medical tourism can be considered a good
solution for Tunisian tourism and orient it towards to sustainable tourism. But some issues attached by
tourism raised require urgent short-term solutions such as politic stability and infrastructures, while
others require a more long-term or structural change.
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